Thursday, November 30, 2017

Hip Pain: Diagnosis and Treatments

Many people experience hip pain from time to time, especially if they lead an active lifestyle. A good deal of walking and hiking while on vacation or rushing to finish chores over the holidays can lead to a sore hip. People experience pain from overdoing it. Known as an “overuse injury,” it results from repetitive stress on the muscles, joints and tendons.

Usually, the best way to deal with pain from overuse is to take it easy for a while. We advise patients to rest their hip, take an over-the-counter anti-inflammatory medication as long as they don't have gastrointestinal issues, and apply ice or heat. If an aching hip doesn’t feel better in a week or so, a visit to a doctor for an orthopedic evaluation is usually in order.     

Sometimes hip pain is a result of a something more serious than overuse, and the following symptoms should prompt you to see a doctor quickly or go to the emergency room:      

·         Intense pain that comes on suddenly
·         Severe pain from a fall or other injury to the hip
·         The inability to put weight on the joint or move your hip or leg
·         A joint that looks deformed or is bleeding
·         Hip pain accompanied by fever and a general feeling of malaise       

For ongoing hip pain, people are advised to see a specialist. Since there can be any number of causes, the doctor should take a detailed medical history, asking plenty of questions. The physician should also perform a thorough physical exam to pinpoint the location and cause of the pain. X-rays often aid in the diagnosis, and an MRI may be ordered down the road.

Bursitis is a common cause of hip pain that usually results from repetitive stress on the joint. The bursae, which are small, fluid-filled sacs that help your joints move smoothly, become inflamed. Pain is usually felt on the outside of the hip. Treatment includes rest, anti-inflammatory medication and sometimes a steroid injection or physical therapy.

Some patients are surprised to learn that their hip pain is actually coming from another part of their body, such as their lower back or knee. 

Arthritis is the most common cause of hip pain in adults over 60, resulting from years of activity and wear and tear on the joint. It’s not uncommon for the arthritis to be accompanied by a labral tear in the hip, which can be likened to a torn cartilage in the knee.  If a doctor recommends arthroscopic , or minimally invasive, hip surgery to repair a torn labrum, patients should get a second opinion. Studies show that arthroscopic surgery for a labral tear has no benefit for older patients with hip arthritis.

Conservative treatments to help relieve arthritis pain include prescribe anti-inflammatory medication, rest and physical therapy. Patients are advised to listen to their bodies and avoid activities that make their arthritis worse. If an individual has excess weight, losing weight may help by taking some stress off the joint.
If arthritis is severe and conservative treatments fail to provide relief, people often consider hip replacement surgery to eliminate pain once and for all and get back to activities they’ve been forced to give up.  More than 300,000 hip replacements are performed in the United States each year.

Major advances in joint replacement techniques and in the implants themselves have revolutionized the field. One such advance is less invasive hip replacement. The newer technique achieves the same goal as the standard procedure, but with a three- or four-inch incision, as opposed to 12 or 14 inches. The surgery entails replacing the painful, arthritic joint with a fully functioning hip implant. Aside from the better cosmetic result, the smaller incision can result in less pain, a quicker recovery and easier physical therapy.  Advances in anesthesia and pain management after surgery have also benefited patients.

This blog should not be construed as medical advice. All questions regarding your health or possible health problems should be directed to your physician.

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Wednesday, September 20, 2017

An Unfortunate Epidemic of Falls this Year

In the past year, four of my close friends or relatives have fallen in their home or at work. Two of them suffered broken bones. In the first instance, a friend of mine was getting ready for a trip to California and rushing around her apartment when she tripped over a pile of papers. She broke her wrist and needed surgery. She’s on the mend and doing well, but it could have been worse.

Another friend was busy at work, and in her haste to get things done, she tripped on some steps and broke her foot. It’s been a long and difficult recovery.

A relative who had back surgery about a year ago became distracted and fell in her walk-in closet. Luckily, she was OK.

Finally, someone I know was adjusting her bath mat and slipped in the bathtub. Fortunately, she fell in such a way that she only sustained a bruise and some soreness.

They all had something in common: they were either distracted or in a hurry. I can’t stress enough how dangerous a fall can be, especially for older folks whose bones may be more fragile. As we age, our balance may not be what it used to be, so it’s more important than ever to be mindful of our movements, especially when we’re in a hurry.

Medications that cause drowsiness also put us at greater risk of falling. Check with your doctor or read the label about the side effects of all your prescription and over-the-counter medications, and be extra careful when moving around the house. 

Shoes and slippers make a difference, too. They should always fit properly, and nonskid soles are advised for people who may be susceptible to a fall.

Ever watch those home improvement shows? It never ceases to amaze me when I see a steep staircase leading to a basement with no handrail. Not only is it against building codes, it’s an accident waiting to happen. Holding on to the wall for support doesn’t cut it. Every staircase in a home should have at least one sturdy handrail. The entire area should be well-lit, with light switches at both the top and bottom of the stairs.

Here are some additional recommendations for home safety and fall prevention:
General tips
  • Ensure that the home is free of hazards such as slippery floors, rugs that are not secured and poorly lit areas. Do not leave piles of paper or random items on the floor. If there is a spill, clean it up immediately.
  • Keep flashlights nearby in case of a power outage.
  • Consider installing motion detector lights which turn on automatically and light your stairway.
  • Put nonslip treads on each bare-wood step.
  • Do not use patterned, dark or deep-pile carpeting. Solid colors show the edges of steps more clearly.
  • Do not place loose area rugs at the bottom or top of stairs.
  • Repair loose stairway carpeting or boards immediately.
  • Install grab bars on the bathroom walls near the toilet and along the bathtub or shower.
  • Place a slip-resistant rug adjacent to the bathtub for safe exit and entry.
  • Mount a liquid soap dispenser on the bathtub/shower wall.
  • Place nonskid adhesive textured strips on the bathtub/shower floor.
  • Use a sturdy, plastic seat in the bathtub if you are unsteady or if you cannot lower yourself to the floor of the tub.
  • Stabilize yourself on the toilet by using either a raised seat or a special toilet seat with armrests.
  • Replace glass shower enclosures with non-shattering material.
  • Clear clutter from the floor.
  • Place a lamp and flashlight near your bed.
  • Install night-lights along the route between the bedroom and the bathroom.
  • Sleep on a bed that is easy to get into and out of.
  • Keep a telephone near your bed.
 Living areas
  • Arrange furniture to create clear pathways between rooms.
  • Remove low coffee tables, magazine racks, footrests and plants from pathways in rooms.
  • Install easy-access light switches at entrances to rooms so you won’t have to walk into a dark room to turn on the light. Glow-in-the-dark switches may be helpful.
  • Secure loose area rugs with double-faced tape or slip-resistant backing. Recheck these rugs periodically.
  • Keep electric, appliance and telephone cords out of your pathways, but don’t put cords under a rug.
  • Eliminate wobbly chairs, ladders and tables.
  • Do not sit in a chair or on a sofa that is so low it is difficult to stand up.
  • Place carpeting over concrete, ceramic and marble floors to lessen the severity of injury if you fall.
  • Repair loose wooden floorboards immediately.
  • Remove throw rugs that are not secured to the floor.
  • Immediately clean up any liquid, grease or food spilled on the floor.
  • Store food, dishes and cooking equipment at easy-to-reach waist-high level.
  • Don’t stand on chairs or boxes to reach upper cabinets. Use only a step stool with an attached handrail so you are supported.
  • Repair loose flooring.
  • Use nonskid floor wax.
Finally, check on loved ones who may be at risk of falling to make sure their homes are safe.

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Wednesday, July 26, 2017

A Letter from a Patient and Some Advice When Choosing a Doctor

This month, I received a letter from a patient that just made me feel good. Most people have excellent outcomes after hip or knee replacement surgery, but it’s not every day that they write a letter to tell you about their experience. Nancy, a teacher from Westchester, wrote a letter thanking me and the staff at Hospital for Special Surgery (HSS) for “a most successful and amazing experience.”  

She had decided to have hip replacement due to intense pain that kept her up at night and made it difficult for her to do the job she loved. Nancy had tried physical therapy, but after 25 sessions and little pain relief, she thought it was time to make an appointment with an orthopedic surgeon. She said three previous joint replacement patients had recommended me, so she felt very comfortable making an appointment. She was also aware of the excellent reputation of Hospital for Special Surgery. Her x-rays, medical history and exam showed that advanced arthritis was causing her pain. She felt confident in her decision to have hip replacement surgery. 

In her letter, she said it was reassuring to know exactly what to expect before surgery, and she was impressed with the attention she received from everyone at HSS. “The hospital experience was everything I could have hoped for and more – from check-in to the recovery room staff and PT personnel as well as the most kind and supportive nurses on the 10th floor…every single person made me feel like they were there to make my experience successful and comfortable.”  

Her letter confirmed that she went into surgery with a positive attitude and without hesitation: “I can’t even imagine a better surgery experience… you were so calm and confident and reassuring before and after surgery. You truly deserve the reputation that precedes you… It’s now almost my 11th week post surgery and I still can’t believe how well I’m walking and moving around in general.  The outpatient PT person is really impressed with my recovery.”

It’s really gratifying to receive a letter like this from a patient. We strive to provide patient care of the highest caliber, to understand each individual’s needs, and to allay any concerns a patient may have. A letter like Nancy’s shows us that we’re doing our job and achieving our goals.

I firmly believe that every patient has the right to expect high quality and compassionate care for whatever medical problem they may be facing and no matter where they are treated. This is especially important for anyone considering surgery. In her letter, Nancy outlined the factors that made her experience so successful, and if you’re considering surgery, I would like to offer the following recommendations to help you choose the right doctor: 

One of the first considerations is whether or not the doctor takes your insurance, and if not, could you go out of network? If you see a physician who is out of network, find out how much of the procedure will be covered and if other professionals involved in your care, such as an anesthesiologist, will be covered. 
Get recommendations for a physician from friends, relatives or from a family doctor. 

Check credentials. See where the physician received his or her education and training. Make sure a doctor is board certified, and don't hesitate to ask.

Be mindful of whether the physician approaches you with professionalism and confidence. You want a confident physician who respects you and appears genuinely concerned for your well-being.  

Don’t rely solely on an advertisement or a physician’s website when choosing a doctor. Advertisements and information displayed on the Internet are not regulated. Ads and websites can often provide useful information, but remember to check the doctor's experience and credentials.

Choose a doctor with whom you feel comfortable and who inspires confidence. Make sure the physician is willing to take the time to answer all of your questions in non-technical terms. If you feel rushed or believe your questions have not been answered in a satisfactory manner, look for another physician.

Make sure the doctor explains what you can expect in terms of the surgery itself, the final outcome and recovery time. The physician should discuss possible risks as well as benefits.

What about the doctor’s staff? Are they gracious and respectful? When you set up pre-surgical testing or receive information about the surgery, is everything explained thoroughly? 

If the doctor dismisses any concerns you may have, dismiss the doctor.

Having a good rapport with your physician will give you a better chance for a successful surgery

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Friday, July 21, 2017

Named Top Knee Replacement Blog by Feedspot

Wow, we've been named a top blog about knee replacement by Feedspot, which lets users read all their favorite blogs in one place:

Thank you for the honor, Feedspot!

Friday, May 5, 2017

Study: Could IV Acetaminophen Reduce the Need for Opioid Medication After Hip Replacement?

When considering joint replacement, many patients worry about how much pain they’ll experience after surgery. It’s a valid concern. Pain control is important not only to avoid discomfort. It’s also essential to get a handle on pain early on so patients can move around and engage in a physical therapy program.  

At Hospital for Special Surgery, we’ve studied pain control at length and have excellent pain management protocols for patients who have joint replacement.  We generally strive to lower patients’ use of narcotic medications known as opioids. Although these medications do a good job at controlling pain, they can have side effects such as nausea, vomiting, dizziness, drowsiness and constipation, which are not only unpleasant, but can make physical therapy more difficult.

At Hospital for Special Surgery, we just launched a study to see if intravenous (IV) acetaminophen can reduce the amount of opioid pain medicine needed after hip replacement surgery. Currently, joint replacement patients generally receive opioids along with the pill form of acetaminophen, commonly known as Tylenol.

We decided to undertake this study because research shows that giving acetaminophen in IV form reaches a higher peak concentration in the blood much faster than oral acetaminophen. Therefore, it may be better at reducing pain than the pill form. 

All study patients will receive the standard pain control protocol, with one group getting IV acetaminophen, while the other group receives the oral pill form. Our goal is to see if intravenous acetaminophen works better than the pill form and can lead to lower doses of opioid medication and more rapid attainment of physical therapy goals.

In addition to seeing if IV acetaminophen can reduce the need for opioid medication, we will be measuring sedation effects, length of hospital stay, and the achievement of physical therapy milestones in patients given intravenous vs. oral acetaminophen.  

Because of its efficacy, general safety and lower risk of adverse effects compared to other pain medications, IV acetaminophen could be an attractive component of the overall pain management plan. If we find that the IV form safely reduces the need for opioid medication, it would be advantageous for hip replacement patients.

For more information about Dr. Westrich and hip replacement, visit:

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Friday, March 10, 2017

Considering a Double Knee Replacement? Here’s What You Need to Know

Orthopedic surgeons perform almost 700,000 knee replacements in the United States each year. The procedure has a high success rate, alleviating pain and restoring an active lifestyle. It’s fairly common for patients to have arthritis in both knees, and they often decide to have both of them replaced. The dilemma many people face is whether to have surgery on both sides at the same time, a procedure referred to as “bilateral knee replacement,” or two separate operations.

I always advise people to carefully weigh the pros and cons of each option. Many people want to have a double knee replacement because they feel they can get it over with faster since there’s one surgery, one hospital stay and one course of rehabilitation. For the right patient, it’s a good option. However, double knee replacement is not for everyone, and people should be well-informed before making a decision.                

Studies show that bilateral knee replacement is a more risky procedure and the complication rate is higher. Rehabilitation is also much more demanding. Candidates must be in excellent physical condition, aside from the arthritis, with no underlying health problems.    

Not too long ago, people thought that if you had one knee replaced, the pain and rehab would be so taxing you wouldn’t want to come back for surgery on the other knee. But nowadays, with advances in surgical techniques, anesthesia and pain management, the recovery for a single knee replacement at a high-volume joint replacement center is much easier and faster than it was in the past. In our experience, virtually every patient comes back for the second knee replacement. Patients generally wait at least three months in between surgeries.
Know What to Expect

Overall, the success rate is high for same-day double knee replacement, but patient selection is important. It should be out of the question for patients of any age with diabetes, heart or lung problems, or any other serious medical condition.

Patients who meet the criteria need to know exactly what to expect so they can make an informed decision about same-day double knee replacement. The recovery and rehabilitation after bilateral knee replacement are much more challenging because greater physical and emotional strain is placed on the body. The rehab is also much more difficult because patients can’t rely on a stable leg for support.

Another consideration is where an individual will receive physical therapy. Bilateral knee replacement patients almost always spend time in a rehabilitation facility after surgery, while those who have a single knee replacement often go straight home from the hospital and receive physical therapy at home.

Whether having two separate knee replacements or both sides replaced simultaneously, the orthopedic surgeon should have a detailed discussion with the patient about what to expect.

Because of the special considerations involved in double knee replacement, it's especially important to choose a highly experienced orthopedic surgeon who specializes in knee replacement. 

Patients should also choose a hospital that performs a high volume of joint replacements, such as Hospital for Special Surgery. The entire staff will be accustomed to dealing with the needs of double knee replacement patients before, during and after the surgery.©

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Wednesday, March 1, 2017

Arthritis "Treatments" to Avoid

Advertisements for treatments claiming to cure or slow down arthritis can be found on the Internet, on television and in print ads. They include drinks, certain supplements and rubs. Most are a a waste of money. 

The ads target people in pain who want to avoid surgery. The problem is, the longer people wait, the worse their arthritis can get. In the beginning, even if these bogus remedies provide a false sense of security, people are actually worse off because they are not receiving the proper care.

The bottom line is that patients should be wary of any advertisement for a product claiming to cure arthritis.

Supplements such as glucasomine and chondroitin, more in the mainstream, are also purported to slow the progression of arthritis. However, in 2013, the American Academy of Orthopaedic Surgeons added these supplements to the list of treatments that provide little benefit.

Knee lavage or “washing out the knee” has also received a thumbs down from the American Academy of Orthopaedic Surgeons. The procedure has not demonstrated any benefit and should not be performed to relieve arthritis. People should be wary if a doctor recommends it.

Another useless “treatment” for arthritis is arthroscopic surgery, with tiny incisions and supposedly a quick recovery.  Although certainly much easier than joint replacement for both the patient -- and the surgeon performing the procedure -- studies show, and we know from experience, that arthroscopic surgery is of no benefit for arthritis and can actually make the pain worse. 

Arthroscopic surgery may be considered to fix a torn meniscus cartilage that is causing symptoms, such as locking or catching in the joint, that physical therapy has not helped. But for someone with arthritis, an arthroscopic procedure is of no benefit.

And not only is it useless, it often makes the condition worse. Every surgery carries some element of risk, so don’t be fooled by the words “minimally invasive.” Countless arthritis patients have come to me after arthroscopic surgery exacerbated their knee pain. One patient developed severe swelling and fluid in her knee after arthroscopy and needed to go back to the doctor every week to have it taken out with a needle, a very uncomfortable procedure.

Surgery is surgery, and all operations have risks and benefits. If an orthopedic surgeon tells you arthroscopic surgery will relieve arthritis pain or buy you time, find another doctor. In fact, if you’re ever unhappy with a doctor, go elsewhere. And it never hurts to get a second opinion, especially when surgery is being considered.

The only tried and true treatment for advanced bone-on-bone arthritis that's causing severe pain is joint replacement. Sometimes, if the arthritis is limited to just one area of the knee, we can do a partial joint replacement, and this is usually easier on the patient. The recovery is generally faster; plus, we preserve more bone.

It’s important to get the proper diagnosis sooner, rather than later. If people wait too long, the joint continues to deteriorate, and a partial knee replacement may no longer be an option. At that point, a total joint replacement will be necessary to relieve pain and restore mobility.©

© 2016 Geoffrey Westrich, MD. All rights reserved.  

Monday, January 30, 2017

Top Myths about Arthritis: Knowing the Facts Can Help You Manage it Better

Arthritis is a painful condition that can make activities of daily living difficult, if not impossible.  Osteoarthritis, the most common form of the disease, affects millions of Americans and is caused by wear and tear on a joint. It often affects the knee or the hip. 

Misconceptions about arthritis are prevalent, but knowing the facts can help people to better manage the disease.

Here are the top myths and facts about arthritis: 

1- MYTH: If you have arthritis, you shouldn’t exercise.
FACT: It may seem counterintuitive, but the appropriate exercise can help many people feel better. Certain exercises, such as swimming or the stationary bicycle, can help relieve stiffness and alleviate pain. Physical therapy or an exercise program to strengthen muscles around the joint can also be very helpful. 

2 - MYTH: Arthritis is a disease of the elderly.
FACT: About two-thirds of patients are under 65. In fact, increasing numbers of people in their 40’s and 50’s are feeling the aches and pains of the degenerative bone disease.

3 - MYTH: Cold, wet climates make arthritis worse.
FACT: There is no scientific evidence supporting the theory that a particular climate is better for people with arthritis. If a warm climate helped or prevented arthritis, then people who lived in mild-climate states such as Arizona or Southern California would not have arthritis. Adults all over the country experience arthritis pain.  However, inclement weather is associated with barometric pressure changes, and this may affect people with arthritis. It does not make the condition worse per se, but it may cause a change in someone’s level of pain.

4 - MYTH: There’s nothing I can do, so I’ll just have to live with the pain
FACT: People can take measures to alleviate arthritis pain. One strategy is to lose weight if one is carrying around excess pounds. Depending on the weight loss, it can take quite a bit of pressure off an arthritic knee or hip. Another recommendation is to avoid any activity, such as going up and down stairs, which may aggravate an arthritic knee or hip. Over-the-counter or prescription pain medication can help. No one needs to live with constant pain.  Joint replacement surgery is a tried and true way to eliminate arthritis pain once and for all. 

5 - MYTH: Supplements and drinks advertised on TV, in print and online can cure arthritis.
FACT: Many products purport to cure arthritis. Some of them are so bold as to claim they can regrow cartilage. Impossible. These unproven potions and pills are a waste of money.  The only way to eliminate advanced arthritis pain is with joint replacement surgery.

6 – MYTH: Arthroscopic surgery will relieve my arthritis.
FACT: Any doctor who says arthroscopic surgery to repair a torn cartilage or clean out a joint will relieve arthritis pain is doing a huge disservice to a patient. This type of minimally invasive surgery does NOTHING to relieve arthritis pain. Not only is it useless and unnecessary, but some patients are actually worse off because their joint becomes inflamed after surgery.

7 - MYTH: How can you have arthritis? You were fine yesterday, how can you be in so much pain today?
FACT: People who have arthritis can feel fine one day, and experience a flare up the next.

8 – MYTH: Even though I have painful arthritis that limits my activities, I’m only in my 40’s, so I’m too young for joint replacement.
FACT: Newer techniques such as minimally invasive hip and knee replacements, partial knee replacements and improved implant materials have made joint replacement a viable option for younger patients who want to alleviate pain and return to an active lifestyle.

For more information about arthritis, including videos, visit

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